National Conference Explores CVD Trends
By Louise Williams
Despite dramatic progress against cardiovascular disease (CVD) in the past half century, challenges remain and new strategies are necessary to overcome such problems as increases in obesity and physical inactivity among Americans.
That was the story that unfolded at a recent conference held to explore trends in CVD and its risk factors. The trans-agency "National Conference on Cardiovascular Disease Prevention: Meeting Healthy People 2010 Objectives for Cardiovascular Health" was held at the request of Congress and drew more than 100 participants to Bethesda for a packed 3-day agenda. Even more participants tuned in to the conference via NIH Webcasting. The conference was sponsored by NHLBI, in cooperation with NIA, the Centers for Disease Control and Prevention, and the Agency for Health Care Policy and Research.
The goal of the conference was to assess the magnitude and trends of America's CVD threat and to start the task of developing strategies to meet the health targets set in Healthy People 2010, the government's blueprint for improving Americans' health. The Healthy People 2010 report will be issued in January.
The CVD conference began with a stage-setting introduction from U.S. surgeon general Dr. David Satcher. He told the group that big gains in life expectancy had been made over the past century, but much more needed to be done.
Satcher said that 15-20 percent of the current Healthy People 2000 objectives had been met and another 60 percent were headed in the right direction. But, he noted that left 20 percent unimproved.
National Center for Health Statistics director Dr. Edward Sondik gave an overview of the rates for CVD and its risk factors. Some rates have slowed their decline. For example, from 1970-1980, deaths for stroke dropped by 20.3 percent and for coronary heart disease (CHD) by 26.1 percent. However, from 1990-1997, deaths for stroke declined by only 2.1 percent and for CHD by only 11.4 percent.
Dr. Shiriki Kumanyika of the University of Pennsylvania School of Medicine illustrated the problem of overweight and obesity. About 15 percent of children age 6-12 years and about 12 percent of those age 12-17 years are obese. Among adults, 39 percent of men and 25 percent of women are overweight, while another 20 percent of men and 25 percent of women are obese.
Speakers also warned that physical inactivity was increasing in prevalence among Americans, while smoking may no longer be declining. About 25 percent of American adults now smoke.
But Dr. Christopher Sempos of the NIH Office of Research on Minority Health reported some good news. He said that "considerable success had been made toward achieving the Healthy People 2000 goal" for total cholesterol.
Other heartening news was that public health education efforts have made many Americans aware of CVD risk factors, particularly those related to diet.
But Dr. George Mensah of the VA Medical Center in Atlanta pointed to the increase in congestive heart failure (CHF), calling it the "final frontier." It is the only CVD diagnosis that has been increasing in deaths since about 1970, he said.
He added that, although the causes of CHF are better known today, doctors are not prescribing the right drugs. For instance, studies show that angiotensin converting enzyme (ACE) inhibitors improve quality of life and reduce CHF deaths by as much as 40 percent, but are not being widely used.
Dr. Gerald O'Connor of the Center for the Evaluative Clinical Sciences at Dartmouth Medical School spoke of the need for better use of existing information. He said this had contributed to geographic disparities in how CVD treatments were utilized.
Participants offered many suggestions for improving CVD trends. Key among these were creating CVD prevention programs to target high risk groups, delivering better practical information to physicians, providing training in CVD prevention to practitioners, reimbursing for preventive services, and forming community and other partnerships to facilitate research and public health promotion efforts.
Presenters also spoke of the need for more comprehensive data in order to better track CVD and its risk factors, especially to improve the health of minorities and to understand geographic differences in both CVD and its treatment. Speakers also said more research was needed on the role of socioeconomic status in cardiovascular health, and on approaches to end health disparities based on race, ethnicity and gender.
Conference chair Dr. Thomas Pearson of the University of Rochester School of Medicine said both a summary article for a journal and a monograph of the proceedings would be published.
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